HomeMy Public PortalAbout8837 ELM AVE_Sewer__ /� q,� n p24650 INSERTS ,�, /�7 q�- - -
76A642.60 (rYPPUCf!'-11 11 iON FOR 9 �,RIIVII T
78A642D COUNTY OF LOS ANGELES SEWER-SEWAGE
p ®—SEppGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION Bu1LDING
ADDRESS
JOHN A. LAMBIE, County Engineer
WILLIAM A. JENSEN, Sup't of Building LOCALITY
n...• _; ., r_.,' .. V.. NEAREST
FOR APPLICANT TO FILL IN CROSS ST. �+
LEGAL OWNER
DESCRIPTION LOT N0. -
IP
BLOCK TRACT j MAIL
ADDRESS
N0.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO. '
USBK P .:,:.
ELDINGS L_` DISTRICT NO. GROUP MAP OCESSED BY
BU /C. L� !'
' I v
CONTRACTOR
ADDRESS Z C014N DATA
CITY '� _ L.NO. t /� p ION DEPTH
REGISTRATION NO.. + j06 C OU
MANHOLE REFERENCE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 - TYPE OF CONNECTION LENGTH FROM _
SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. L.TO P.L. '
ITS AND/OR DRAINFIELD @ $3.00 ,
OVERFLOW SEEPAGE PIT,DRAINFIELD -
c
EX N..CESSPOOL. DRYWELL @ $2.00
P.C.N0.
HOUSE SEWER CONNECTING TO CO.IMP. NO. JOBNO.
PRIVATE DISPOSAL SYSTEM @ $1.00 W
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT N0. V
WORK TO HOUSE SEWER @ $1.00
ALTER, REPAIR
DISPOSAL ABANDON HOUSE @ $1 00 STATE ENCROACHMENT W.
PERMIT NO. -
INDUSTRIAL - U
` WASTE APPROVAL op W
CHARGES En
OWNERS PERMIT $ CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE 1 dad J. REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESC ED EXISTING DWELLING n - APPROVALS �. DATE 'INSPECTOR'SSIGNATURE
TO THE PUBLIC SEWE
SIGNED THIS f D OF 19 NEW_Ua sE-SEWERdG!;4/l
'. OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
HEREBY ACKNOWLEDGE THAT I HAVE- READ THIS APPLICATION - -
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ' CESSPOOL ❑ DRYWELL ❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. a SEWAGE DISPOSAL SYSTEM
1-HEREBY CERTIFY THAT I AM PROPERLY STERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES• OUNTY ND STATE OF .DISCON N DISCONNECT
SEWER '
CALIFORNIA OR THAT M THE - WNER F THE ABOVE
? DESCRIBED RESIDENT L ROPERTY BACKFILL SEPTIC TANKS ❑
S P.PIT(S) CESSPOOLS ❑
SIGNATURE
OF PERMITTE
OF ALIDATION ROBERT A. WOOD
CK. M.0• CASH SUPERVISING MECHANICAL ENGINEER
24650 INSERTS
CE606 6.60
76a642D n ^PUCAc ® CFOR P E R M T
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL,
.
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Engineer
e 'ADDRESS L
WILLIAM A. JENSEN, Sup't of.Building. LOCALITY C / i
NEAREST �.
FOR APPLICANT TO FILL IN ceoss sr.
LEGAL _ y� LL,,./1 �--� • '
DESCRIPTION LOT NO. V Aho OWNER _��
BLOCK TRACT MAIL
ADDRESS
NO.OF BL GS. - - '
SIZE OF LOT NOW ON LOT CITY. TEL. NO.
USE OF
BUILDINGS ./��C�' g DISTRICT NO. GROUP BK MAP , PROCESSED BY
I��� ^� PG - � •
CONTRACTOR ! I dq I
ADDRESSQ'✓! CO NECTION DATA -
CITY TEL.N0. ST N r A DEPTH, D
STATE MANHOLE REFERENCE
REGISTRATION NO. COUNTY f LOWER
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER Co) $3.00 TYPE OF CONNECTION LENGTH FROM 0 _
SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. - M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD '
EXTN..CESSPOOL. DRYWELL @ $2.00
.
HOUSE SEWER CONNECTING TO C.NO.
CO.IMP. NO. a JPOB NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 ..J
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT N0. ROAD PERMIT N0. ,.� �o - O
WORK TO HOUSE SEWER @ $1.00 U
ALTER, REPAIR OR ABANDON HOUSE s' STATE ENCROACHMENT al
_ SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO. O -
INDUSTRIAL V
WASTE APPROVAL W
CHARGES P4
OWNER'S PERMIT $ 2 00 CONNECTION CHARGE'FEE
r. AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT DATE A CONTRACT WITH
TRACTOR TO CIONNECT THE ABOVE ESCRIT HE ED EXISTIfNGAMED DWELLIONG ' APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED.THIS f�!/D�AAY 0 19 NEW HOUSE SEWEROWNER OR / (h'r(Q•J /��'�Y'T
t OWNERS AGENT - ! CONNECT ADDITIONAL `� U
., BUILDING OR WORK -
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
HEREBY. ACKNOWLEDGE THAT I. HAVE READ,THIS APPLICATION
�+ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑ -
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR _
PLUMBING AND SEWERS. - SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER -
CALIFORNIA OR THAT I THE LEGA N F THE ABOVE
DESCRIBED RESID ENTI PR PERTY.� ` .. BACKFILL SEPTIC TANKS El
SIGNATURE / SEP.PIT(S)Z CESSPOOLS ❑ - -
•
OF PERMITTEE
OF JALIDATION 'ROBERT A. WOOD
Gy
M.0. CASH SUPERVISING MECHANICAL, ENGINEER
L { ol0 1 ' ' il1. 61 A 5.00